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The New South Wales (NSW) Health Department and the Ambulance Service of NSW introduced a trauma bypass system in Sydney on 29 March 1992. This study aims to review the outcomes of trauma bypass patients brought to St George Hospital, a major trauma service in south-eastern Sydney, and to assess the performance of the current prehospital trauma triage protocol.The St George Hospital Department of Trauma Services prospectively collected data on all trauma bypass patients for the 8-year period from 29 March 1992 to 29 March 2000.A total of 1990 patients were brought to hospital on trauma bypass. The average age was 32 years, 70% were men and 66% were from road traffic accidents. The positive predictive value of the prehospital triage tool for serious injury (Injury Severity Score[ISS] > 15) was 18.6% (95% CI 16.9–20.4). This is well below the benchmark previously established by the NSW Health Department Trauma System Advisory Committee. For all trauma bypass patients, 33.8% (95% CI 31.7–35.9) were discharged home from the ED. The overall death rate was 2.5% (95% CI 1.9–3.3).According to the proposed benchmark, current prehospital trauma triage guidelines are underperforming. This suggests that a review of the benchmarks of current local trauma systems and of the trauma triage tool is required. [ABSTRACT FROM AUTHOR]